Neuropathic aid



M y 1943- o. s. CAESAR NEUROPATHIC AID Filed April 19, 1946 3 Sheets-Sheet l May 4, 1948. o. s. CAESAR NEUROPATHIC- AID Filed April 19, 1946 3 Sheets-Sheet 2 Q JZ in r1149.

May 4, 1948. o. s. CAESAR 2,440,894 r maiunormmc AID Filed April 19, 1946 3 Sheets- Sheet s J3 1617 Jig 707 17g Patented May 4, 1948 UNITED STATES PATENT j OFFICE 2,440,894, NEUROPATHIC All) Orville S. Caesar, Barrington, 111. Application April 19, 1946, Serial No. 663,474 3 Claims. (01. 128-80) This invention relates to improvements in devices adapted to assist a patient to walk, following neurologic or muscular disfunction, due to disease, or trauma.

While the invention is believed to be useful in more than one neurologic or orthopedic condition, the device herein was particularly'designed for use in a condition known as dropfoot, in which there is the inability to voluntarily move the foot upwardly. The condition results from palsy of the anterior tibial nerve. Such a patient needs a device adapted to apply just the right degree of upward pressure on the foot to compensate for the loss of nervous control of muscular power, and to permit and to assist to such ankle-joint motion as is needed in walking. Since there are varying degrees of palsy and since varying degrees of pressure support are sometimes needed during the course of healing of a particular case, it is needful to provide some simple easily applied device that will subserve such requirements. ,The patient also needs a device which he can himself take off and put on, and by which just the right degree of upward force needed in his individual case can be applied. This invention provides a device highly adapted to the above needs.

Moreover the device; should be comfortable; should be easily' attachable. and removable; should be light in weight as possible; should be strong and durable; should not be unsightly; should have a minimum of projecting parts; and should be relatively cheap. The present invention provides all of the above mentioned qualities and advantages.

I am aware that various devices of this general nature have been heretofore made but all of them have some objections, which I have overcome by the structure shown herein. For example, some of the prior devices must be built into the shoe at the time of manufacture so that new shoes must also be purchased to obtain the device. No change or adjustment can be made. Others are provided with pivoted joints which cause friction and which are unsightly. Others have leg-engaging portions that engage the medial rather than the posterior surface of the leg. Others use straps which encircle the leg and unduly constrict and cause considerable disagreeable friction. Others are attached to points laterally of the shoe or heel and form a rigid support. Others have parts which engage, rub the ankle joints and which are often unbearably painful.

Other objections in regard to various prior that inner surface.

devices known to me are: Difficulty in obtaining the right feel and the right degree of orthopedic pressure; inability to adjust the device in any way whatever to make it comfortable, for all motions of: the foot and leg in walking; difficulty of attachment; unsig'htliness of the devices by which attachment is made; projection of parts in such manner as to be caught in the bottom of the trousers; and projection of the parts in such manner as to make the wearer stumble and/or fall due to engagement of the parts by the shoe of the opposite leg.

The nerves supplying the anterior muscles of the leg are often injured during the course of poli'omyelitis, and aids or the kind herein are therefore frequently worn by children. They may be worn for extended periods of time. It is then important; that the device be of a minimum weight; that the parts project laterally only in a minimum degree, and not in a manner to trip the wearer; that the device be capable of easy attachment and detachment and; that provision be made for varying degrees of upward pressure. This invention provides for all of the above needs.

Features and advantages of the invention will appear in the description of the drawings, and in said drawings- Fig. l is a side applied and with the ly in section;

Fig. 2 is a rear view of Fig. 1;

Fig. 3 is a vertical transverse section on line 3-3 of Fig. 1 showing the way in which the device is attached;

Fig. 4 is a bottom plan view;

Fig. 5'is a vertical longitudinal section taken on line 5-5 of Fig. 4; and

Fig. 6 is a plan section taken on line 6-6 of Fig. 1.

Now referring to the drawings. The shoe has the usual upper l, heel 2, bottom instep surface 3, forward vertical heel surface 4, forward sole portion '5, and insole 6.

It is important to provide a very simple form of attaching means. To this end a single opening 8 is made through the instep portion of the sole about midway of its transverse dimension. Into this opening 8 is inserted an interiorally threaded cylindrical stud 9. A press-fit connection is made. The stud is of one piece with a thin circular plate or head l0 and this head is preferably embedded in the bottom surface of the inside of the shoe with its upper face flush with The head has punched-out leg-engaging element part- ,elevation showing the device projections H which enter the leather to prevent rotation of the stud, and the head may have openings for suitable fastening devices. The insole 6 covers the head Ill.

The shoe is now conditioned for the attachment of my pressure-applying structure which may be considered as a lever-like structure comprising a pair of arms having a common fulcrum, the lever being made of, material which will apply yielding pressures The fulcrimiing-i structure comprises a metal block I2'havingacentrai' opening I 3 for the reception of a fastening screw, M. This screw passes through the opening I3 of" the block and has threads engaged withithevin terior threads of the stud 9. The block has a countersunk depression 15 to receive tl'ieconical head It of the screw, and the driver slot ll of a width to receive a coin suchas a dime, to be used as a screw driver. Thusw single screw secures therrblock to the shoe.

The-'2 rearifacei'of the? block; engagesrthecfronti face d'iofcthe' heel andithe'uppenfaceiof th'ebloclc is ifonc'edztightly. against therunder.suriacesofjthe; instep-by means :oiithe' screw: Engagement of the.- block with the heel:preventsblocktrotationzz: Ifthe :front surface-:llioftheheeiisiswriginallymurycd; transverselyoffthe shoe-:aszisflfrequently thezcfise; the surface is rpreferably made flairythroughoutjts lngthtcrosswiseofitheshoe'z:

The forceeapplyingeelement:is:herein: made-:ofi a 'single'iipiecetiof wire; such-:as-zpianw wires; The: wire is relatively small in diameter iso=asxto be'aa inconspicuous. asiipossible; The:- quality: ofr the wireris important? Therwire must berresilient; that is} capable'rofi springsiorceeapplyingsactionr Various. gradeskof wirez resiliency; cam bev-h'adeto: obtaini the correct" pressure characteristic for each cases This;w-ireermaterial is-iormable; that: is, carr beagiyenszavsuitabie formzas showm The elementstof the long arm canzbeamanipul'ated or bent iby' thea user i to slightly-change: its contoun conformable Ito the-:needs.v optimunrcomfort;- while rthe:"forceeapplyingctcharacteristic is aitzall' timesmaintainedr In forming the arms the wire is firstjbent mid-- way ofits length to provide'thezfforwardiyzextermingsshortiarm 2|I:of -v the? lever: system tWGj-Oflll; spring sections 2!, 22 are then formedzsozasytwbei axially aligned and lieat; opposite 'sides-ofiithe vertical" faces of:: the." block: I217 Pins; 25 are: threaded into the block and pass through the coils and each pirr has;ascrew-driver slot%'26. Theseipin-s anchor therlever; structure and act as supports? for the coils 2:! 22 "and-1 act as-fulcrumsf or the lever arms.

From the outer endt'of each coil:therwire is extended horizontal-1y as at; '21 int amdirection substantially parallel with thecax-iseof 'the coils--.tor-a: point beyond vverticalplanes-passing through the side surface of the heel portion of the shoe. The Wire *is then" so bentas 120:: slant upwardly and reat-wardly as at 28::in opposition. to-the sides-c the rear'portion 'ofthe' upper; ThBn'WilffiSrCllTVBj as at 29 and extend upwardlyagatfifldn: a-more; upright" position and: are preferably slightly curved in a forward direction-y andehave; their upperlends attachedtas-at :31 to; the outerrside of athinplate 33 oflightsteel: oi; somewhat; Ux-"shaped form as viewed from -thetopp The connection ofthe plate 33.-is preferably made: by, welding, Thaplate. is suitablypadded rasuat .34-. and the paddingiscovered Witha suitable finish ing; material 35, preferably-leather.

It isthrough; this padded element that pressure is transmittedto:therposterior portion of the lcgc -head ..has al'screw- The padded leg element is not secured but is so placed that The first is that the Wire has the proper resiliency to:- obtain the proper degree of pressure, respectivelyupwardly against the instep and forwardly against tlieback of the leg. The second is that elemcntsnof .thelong arm which includes the portions 29 and '3ll"are to some extent formable byihandinanipulation to make this arm conform to the leg contour and pressure needs of the particular personrwhois wearingtthedevicee In-no devioeknown to ma except-the devioechereimcanslight buhrneediule variations in: degrees, 0t. pres-e sure be so easily obtained.

Fig.- 1; at, 40 :showainidot-andsdash lines-how the contoun-ofethe portions29 and 30,01 "the, legpressurea-rms can bechanged; In-Eig. 2,dot-anddashalines indicateat 4+- how the elements 3l1can berben-t inwardly,- amt-it is .understood that: they cam-alsQnbe bent outwardly; Ghangeroi-contoun ofthewireselementssmay be utilizedrto-l slightly change-the point or :applicat-ionof the l pressure; Flor example, referringto-lii'gr 1, if, the portionrim is-bent routwardlyathe, padded legeengagingelement-"will: be moved. slightly downwardly. If 30 is;bent toaistr'aighterpositionthe leg-engaging elementwill .be :movedsslightlympwardly. Moreover, Y by, such, at manipulationpnessure point re.- lationshipbetween lever Zllhndthedeglever, both. inc. relation to, the ankle joint, are .obtainable: This featuhe isrrelatedtenths,pressureffel! of thepatient. Generally, speaking, each patient needs-a speciaiadiustment' oi' ith'e device to suit him I It the user-iwishes .to; remove' thedevices-while sitting, th is -.1can.rbeeasily=- and quickly. accomplished by unscrewingasingle screw,

To,attachthmdevice allvthatisrnecessary-into stand'onthe devicelby placing the .sole onthe arm at; to fiattndt. Then theiopening in the block is-registered with opening; inflth'e, shoe, ,and then the screw this. applied and screwed into p -lace. using, ifv desired,. th"e edge :of. a-coin" to act :as a. screw. driver.-

It will be noted that'the attaching ipointv for the arms is disposed. below and forwardly of the ankle bones or ankle joint, and that 'the portions 28,129 lie, at a levelubelow the: ankle bones; The rear arm 15: 50.- shapedi-that. its parts-never assume a position in: opposition,-tothose bones: and thereforeccanrnever-rub or. injure-them.

It is rto rlbe. noted .that the single-piece. resilient legecngaging and insteprengaging elementhas two-parts one of which applies: an upward thrust against the, instepr andthe :other-of which appliesa forward? thrust againstthe posterior surface of theylega Both thrusts having a common fulcrumpoint which lies on atraverse-line, disposed for= wardly-of andvbelow-theeankle. joint. Thus, theforward-partlm tendscta raiserthe foot-and thus oppose; foot-drop,a tendency and 1 this actionis ewhat maybeiconsidered one arm.

performed-lb ofa-lever,.the--upper partiof the-Other armor which engages the posterior of the leg.

Itwillbciindcrs codithat-thedegreeof resilient action or thrust action of the arms can be varied, and it is contemplated herein to provide individual resilient elements of difierent degrees of resiliency, any one of which may be selected for substitution, so that the patient has a choice which permits him to obtain a device having exactly the right resiliency or feel suitable for his particular case.

It is to be noted that the parts 21 which project laterally beyond the shoe, s0 project at such a low level and forward position as to preclude the possibility of the trousers catching thereon. Above this point the wire arms are so formed as to preclude the possibility of the trousers being caught therein. Moreover, there is a minimum of projection, which makes it unlikely that the foot of the opposite leg will accidentally engage any projecting part. Therefore, the manner of attaching the device entirely to the underside of the shoe and forming al1 laterally projecting parts in a manner to prevent snagging of the trousers, or tripping, is an important feature.

During walking the leg of the foot which is moving forward, swings 'rearwardly about the ankle joint as a center. When this occurs greater rearward pressure is put on the leg-pressing arm to move it rearwardly and therefore greater upward pressure is brought to bear against the bottom of the instep to keep the foot raised. When the leg swings forwardly about the ankle as a center, the leg-pressing element moves forwardly but its tension is lessened and correspondingly the tension on the element 20 is lessened. Thus, varying pressures occur conformably to the position of the leg and foot in walking.

An important advantage is that the present device can be removed and applied to any one of several shoes and that substitute supporting or force-applying elements can be used, each painted to have the same color as the shoe on which the device is to be worn. Where the color of the wire and of the shoes and the hosiery are the same, the brace is barely noticeable. This is important to all who must wear corrective, or supportive appliances.

What I claim is:

1. A device of the class described comprising, a block having an opening through which a fastening device is adapted to be passed to secure the block to the undersurface of the instep of a shoe, said block having at each opposite side a lateral projection adapted to lie horizontally when the block is attached, said projections being axially aligned and adapted to be disposed transversely of the shoe, a structure made of a spring wire having spring coils, one supported on each lateral projection, the inner end of the coils merging to form an arm adapted to apply upward pressure against the under surface of the shoe fore wardly 0f the block and the outer ends of the coils merging into extensions which pass laterally then rearwardly and upwardly at the outside of the shoe to a point rearwardly of the leg and above the ankle of the wearer of the shoe, the upper ends of said extensions being attached to a padded element which is adapted to engage and to be pressed against the posterior surface of the leg by said extensions.

2. A device of the class described comprising,

a shoe havingv an opening extending entirely through the instep portion of the sole, an interiorly threaded stud secured in said opening, a block engaging the undersurface of the instep and the forward surface of the heel, a screw passing through the block and threaded into said stud and securing the block, said block having extending from each opposite side a pin having threaded engagement with the block, a resilient wire structure having spring coils one surrounded and supported by each pin, the coils at their inner end merging into a spring arm which applies upward pressure against the instep at a point 10rwardly or the block, the outer end of each coil merging into an arm which extends laterally beyond the sides of the shoe, then rearwardly then upwardly, said arms being attached to an element which is adapted to be pressed into engagement with the posterior surface of the leg of the wearer of the shoe.

3. A device of the class described comprising a spring wire structure provided with axially aligned coils adapted to underlie the instep of a shoe, the adjacent ends of said coils providing an arm extending forwardly of the shoe and pressed upwardly against the bottom thereof by the spring force of said coils, the opposite ends of said coils providing arms extending upwardly laterally of the shoe and being pressed forwardly by the spring force of said coils, and means for securing said coils in position under the instep of a shoe and within the marginal edges thereof.

ORVILLE S. CAESAR.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS Name Date Stillman Sept. 13, 1881 OTHER REFERENCES Number 

